| NPI | 1760739502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P6658) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60281186) |
| Enumeration Date | 2012-08-11 |
| Last Update Date | 2012-08-11 |