| NPI | 1194023028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60203050) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0012353) |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2012-03-27 |