| NPI | 1801924600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00048407) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0009736) |
| 183500000X Pharmacist (Licence: CA RPH-37804) | |
| 183500000X Pharmacist (Licence: NV 08606) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2009-12-01 |