| NPI | 1538490537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P5701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph00040548) |
| 183500000X Pharmacist (Licence: WI 12795-40) | |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2010-01-15 |