| NPI | 1578795910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60523441) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0011001) |
| Enumeration Date | 2009-08-19 |
| Last Update Date | 2022-07-21 |