| NPI | 1477929677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60840795) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 24132) |
| 183500000X Pharmacist (Licence: AK 2239) | |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2019-10-09 |