| NPI | 1114474103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60128771) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0012606) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2016-09-07 |