| NPI | 1174994651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OR RPH-001148) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH 60293507) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2015-10-09 |