| NPI | 1831595289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0014615) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60469795) |
| Enumeration Date | 2014-11-12 |
| Last Update Date | 2015-05-22 |