| NPI | 1518214006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 60254646) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18266) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2012-08-14 |