| NPI | 1003000993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60444168) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03129498) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2014-12-11 |