| NPI | 1629051453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00011051) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH 35915) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2008-09-11 |