| NPI | 1154670578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60295293) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-12297) |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2012-08-30 |