| NPI | 1962796821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00010973) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 1839) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2011-06-07 |