| NPI | 1104858083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 4854022-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00056436) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-08-22 |