| NPI | 1568244077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61450082) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P10988) |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-10-18 |