| NPI | 1386929818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 60274917) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17917) |
| Enumeration Date | 2011-10-16 |
| Last Update Date | 2014-01-30 |