| NPI | 1568030773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61187298) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR60798878) |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2021-11-17 |