| NPI | 1952698599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 00016790) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0007962) |
| Enumeration Date | 2011-07-04 |
| Last Update Date | 2011-07-04 |