| NPI | 1639453343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 48073) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60095982) |
| 183500000X Pharmacist (Licence: AZ S017751) | |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2011-09-30 |