| NPI | 1063785954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph00011475) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 37347) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2012-02-22 |