| NPI | 1114665635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61326986) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 60883898) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2022-09-05 |