| NPI | 1225301807 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 7229) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00039963) |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2012-02-14 |