| NPI | 1447823125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61168636) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P9476) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2021-08-10 |