| NPI | 1942278395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 2797369-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph00022047) |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2010-12-13 |