| NPI | 1215676960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA ph61190155) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID p9975) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-06-01 |