| NPI | 1831522135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0013654) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60377444) |
| Enumeration Date | 2013-08-10 |
| Last Update Date | 2013-08-10 |