| NPI | 1497030712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 60244426) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0012781) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2023-05-09 |