| NPI | 1043789803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60868283) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0017270) |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2020-04-23 |