| NPI | 1356697411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph00069013) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 10836) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2012-07-26 |