| NPI | 1043615842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60040384) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 18381) |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2014-10-23 |