| NPI | 1013490937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P8133) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60839230) |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2018-09-07 |