| NPI | 1174932032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60438370) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OH 03131806) |
| 183500000X Pharmacist (Licence: OR 0013948) | |
| Enumeration Date | 2014-08-05 |
| Last Update Date | 2020-10-26 |