| NPI | 1558694836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60096490) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR00061853) |
| 183500000X Pharmacist (Licence: ID P6463) | |
| Enumeration Date | 2009-09-17 |
| Last Update Date | 2021-05-04 |