| NPI | 1376044222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 61319269) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0016478) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2024-08-19 |