| NPI | 1194028282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 13374) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 60239478) |
| 183500000X Pharmacist (Licence: OR 0013600) | |
| 183500000X Pharmacist (Licence: AL 17944) | |
| Enumeration Date | 2010-12-10 |
| Last Update Date | 2015-06-02 |