| NPI | 1326303751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60282778) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 16990-4) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2016-01-13 |