| NPI | 1104158682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60020029) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH0011351) |
| 183500000X Pharmacist (Licence: TX 54396) | |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: OR RPH0011351) | |
| Enumeration Date | 2010-02-08 |
| Last Update Date | 2018-06-16 |