| NPI | 1275860736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60539913) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 59276) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2021-07-29 |