| NPI | 1376788059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 8738) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00017453) |
| Enumeration Date | 2008-12-09 |
| Last Update Date | 2009-01-20 |