| NPI | 1952694119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00008071) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P3561) |
| 183500000X Pharmacist (Licence: UT 5951006-1701) | |
| Enumeration Date | 2011-05-20 |
| Last Update Date | 2011-05-20 |