| NPI | 1194353805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID I63666) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR60900576) |
| Enumeration Date | 2020-03-29 |
| Last Update Date | 2023-07-14 |