| NPI | 1659688919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 00071722) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0009813) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2010-09-08 |