| NPI | 1710380357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph60091249) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID p5260) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2014-09-26 |