| NPI | 1346657475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60451586) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P7053) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2014-07-21 |