| NPI | 1790848018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00009095) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 25921) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2012-12-20 |