| NPI | 1215440573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60711839) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0015634) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2019-06-07 |