| NPI | 1063777209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 16706-40) |
| Additional Taxonomies | 146M00000X Emergency Medical Technician, Intermediate (Licence: WI 7023565) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2024-01-21 |