| NPI | 1588036685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0014361) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 60277645) |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2015-10-28 |