| NPI | 1588928576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 00062919) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0010759) |
| Enumeration Date | 2012-06-25 |
| Last Update Date | 2012-06-25 |