| NPI | 1093066342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR PI-0010778) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR 60281819) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2014-03-14 |