| NPI | 1528241544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00042474) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0010308) |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2007-12-12 |