| NPI | 1003107624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60046903) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph60046903) |
| Enumeration Date | 2011-04-30 |
| Last Update Date | 2021-09-14 |