| NPI | 1003210766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 71459) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00066399) |
| 183500000X Pharmacist (Licence: AZ S018484) | |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2014-10-09 |