| NPI | 1659369668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 2940) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00040684) |
| Enumeration Date | 2005-10-12 |
| Last Update Date | 2007-07-08 |