| NPI | 1811331242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60340700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S019200) |
| 183500000X Pharmacist (Licence: MT 12240) | |
| Enumeration Date | 2013-04-29 |
| Last Update Date | 2013-04-29 |