| NPI | 1114078540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P4553) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00011839) |
| 183500000X Pharmacist (Licence: MT 2732) | |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2011-09-20 |