| NPI | 1568930121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60918750) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2018028745) |
| Enumeration Date | 2018-11-12 |
| Last Update Date | 2020-12-02 |