| NPI | 1023011319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA PH10516) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: ID P5225) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2014-11-20 |