| NPI | 1588918593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00009733) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6445) |
| 183500000X Pharmacist (Licence: OR RPH0012513) | |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2012-10-30 |