| NPI | 1255720934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60486320) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY I20059834) |
| Enumeration Date | 2015-01-17 |
| Last Update Date | 2015-01-17 |