| NPI | 1578834115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00048652) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR rph-0010168) |
| 183500000X Pharmacist (Licence: OK R-12532) | |
| Enumeration Date | 2012-01-12 |
| Last Update Date | 2012-01-12 |