| NPI | 1811305212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00040446) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 13993) |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2014-07-29 |