| NPI | 1205559317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61231754) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 19317) |
| Enumeration Date | 2022-09-22 |
| Last Update Date | 2022-09-22 |