| NPI | 1568605251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60227234) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: WA PH60227234) |
| Enumeration Date | 2009-04-11 |
| Last Update Date | 2016-11-14 |