| NPI | 1104103605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 50717) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60130978) |
| Enumeration Date | 2011-11-11 |
| Last Update Date | 2017-04-05 |