| NPI | 1821351776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60150717) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 10095) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2012-06-15 |