| NPI | 1164931416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60823134) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0016149) |
| 183500000X Pharmacist (Licence: MD 25179) | |
| Enumeration Date | 2017-09-29 |
| Last Update Date | 2018-08-11 |