| NPI | 1073838637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph00016468) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 8958) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2017-12-24 |