| NPI | 1124164181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00057111) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP036015L) |
| 183500000X Pharmacist (Licence: AK PHAP1491) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-10-04 |