| NPI | 1558778431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60482605) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 122182) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA IR60471093) | |
| Enumeration Date | 2014-07-12 |
| Last Update Date | 2022-01-05 |