| NPI | 1386014371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P9968) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 60473037) |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2022-05-19 |