| NPI | 1952707713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph60268815) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 6652) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |