| NPI | 1174507610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00010939) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 10718415-1701) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2021-07-02 |