| NPI | 1255766549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60797589) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS51132) |
| 183500000X Pharmacist (Licence: CO PHA.0020234) | |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2025-02-04 |