| NPI | 1609896984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00013746) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 150393-1701) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2013-06-27 |