| NPI | 1952632572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph00049819) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT mt4525) |
| Enumeration Date | 2010-01-21 |
| Last Update Date | 2010-01-21 |