| NPI | 1447771076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60674187) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0015930) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2017-07-05 |