| NPI | 1285164764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0016306) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60837611) |
| Enumeration Date | 2017-06-15 |
| Last Update Date | 2022-07-21 |