| NPI | 1558873190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA WA50999) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA RPH50999) |
| 183500000X Pharmacist (Licence: CA RPH44850) | |
| Enumeration Date | 2017-11-03 |
| Last Update Date | 2018-06-16 |