| NPI | 1518121995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA P460236329) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS43661) |
| 183500000X Pharmacist (Licence: CO PHA-18417) | |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2011-08-04 |