| NPI | 1043829906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P8920) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61049973) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2021-12-13 |