| NPI | 1992778179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00059773) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 5064) |
| 183500000X Pharmacist (Licence: RI RPH02217) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2007-07-08 |