| NPI | 1164792495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: WA PH00068241) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: TX 21486) |
| Enumeration Date | 2012-01-03 |
| Last Update Date | 2012-01-03 |