| NPI | 1285049098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60419201) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6871) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2014-07-01 |