| NPI | 1518214931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph60298525) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 7452097-1701) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2012-08-06 |