| NPI | 1770953275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60555387) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18087) |
| 183500000X Pharmacist (Licence: AZ S016093) | |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2015-09-28 |