| NPI | 1497078778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 13029) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00019467) |
| 183500000X Pharmacist (Licence: HI 3339) | |
| 183500000X Pharmacist (Licence: AK 2088) | |
| Enumeration Date | 2010-03-01 |
| Last Update Date | 2014-08-15 |