| NPI | 1558606566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7452115-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60299522) |
| Enumeration Date | 2012-12-02 |
| Last Update Date | 2012-12-02 |