| NPI | 1215369624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0013650) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60341010) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2013-08-08 |