| NPI | 1497193296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA PH60632918) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S019784) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2019-10-10 |