| NPI | 1316910151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 11541) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 37976) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2013-02-01 |