| NPI | 1497061337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60142970) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 65389) |
| Enumeration Date | 2010-08-30 |
| Last Update Date | 2015-12-23 |