| NPI | 1962731901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60028524) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17414) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2009-12-22 |