| NPI | 1336137355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00009581) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0009464) |
| 183500000X Pharmacist (Licence: MI 5302032153) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2007-07-08 |