| NPI | 1396287850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60972542) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA IR60598332) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2019-10-24 |