| NPI | 1538499900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: OR 5396) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: WA 14617) |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2010-01-07 |