| NPI | 1679902951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID p6899) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 60395020) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2013-11-06 |