| NPI | 1205808177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 119545) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 2878) |
| 183500000X Pharmacist (Licence: WA PH 60183445) | |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2012-11-27 |