| NPI | 1992828248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00061319) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 16854) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |