| NPI | 1558577445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P9982) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00041625) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2025-01-31 |