| NPI | 1306404041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7073375-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60946298) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-29 |