| NPI | 1235607722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH0016808) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60879431) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-02 |