| NPI | 1740612670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 70549) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60373244) |
| Enumeration Date | 2013-08-02 |
| Last Update Date | 2014-08-05 |