| NPI | 1326419219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60569900) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS52297) |
| Enumeration Date | 2015-10-17 |
| Last Update Date | 2015-10-17 |