| NPI | 1932495801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P5781) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 9806) |
| 183500000X Pharmacist (Licence: WA PH00042864) | |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2011-06-20 |