| NPI | 1336498922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00071039) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 5258820-1701) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |