| NPI | 1336581768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 11675) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 22018) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2013-07-26 |