| NPI | 1154921849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60856202) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 11343992-1701) |
| 183500000X Pharmacist (Licence: CA 82127) | |
| Enumeration Date | 2020-10-30 |
| Last Update Date | 2020-10-30 |