| NPI | 1487956231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 6052) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00010260) |
| Enumeration Date | 2010-11-30 |
| Last Update Date | 2010-11-30 |