| NPI | 1487958849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60149532) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 52524) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2018-10-16 |