| NPI | 1073842019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60087291) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AK 1862) |
| Enumeration Date | 2009-12-22 |
| Last Update Date | 2022-08-15 |