| NPI | 1942594296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00067684) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC PH10679) |
| 183500000X Pharmacist (Licence: WV RP0006822w) | |
| Enumeration Date | 2011-06-03 |
| Last Update Date | 2011-06-03 |