| NPI | 1356749972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0010717) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 00062359) |
| 183500000X Pharmacist (Licence: ID P6220) | |
| Enumeration Date | 2014-12-13 |
| Last Update Date | 2014-12-13 |