| NPI | 1386936888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 24624) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60156213) |
| 183500000X Pharmacist (Licence: NV 15756) | |
| 183500000X Pharmacist (Licence: PA RP446512) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2015-07-21 |