| NPI | 1104200351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60658441) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-16933) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2022-11-06 |