| NPI | 1124329651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P-4526) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 00009240) |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2010-11-15 |