| NPI | 1205834538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KS 1-12764) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph00020382) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2007-07-08 |