| NPI | 1356516785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 42244) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 100567) |
| Enumeration Date | 2008-04-27 |
| Last Update Date | 2015-09-25 |