| NPI | 1215597893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60953468) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P8393) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2019-07-13 |