| NPI | 1366996068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA IR60354600) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60675487) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2016-08-10 |