| NPI | 1154077188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph61282763) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 30505) |
| Enumeration Date | 2022-02-28 |
| Last Update Date | 2023-05-01 |