| NPI | 1700854510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA PH00010060) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SD 3790) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2008-10-03 |