| NPI | 1497002299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00022224) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID p4819) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2021-02-24 |