| NPI | 1770854903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ S12150) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph 60041249) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2015-03-30 |