| NPI | 1316457021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0016397) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60683159) |
| Enumeration Date | 2017-10-07 |
| Last Update Date | 2018-10-01 |