| NPI | 1679854251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00055761) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6216) |
| 183500000X Pharmacist (Licence: IL 051-292929) | |
| 183500000X Pharmacist (Licence: MT 6769) | |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2011-09-08 |