| NPI | 1184040339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60399423) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 14191) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2014-03-12 |