| NPI | 1043387103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 30420) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00060969) |
| 183500000X Pharmacist (Licence: NV 16583) | |
| 183500000X Pharmacist (Licence: CO 17051) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |