| NPI | 1881858033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: MN 119957) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60021557) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2011-05-08 |