| NPI | 1588914592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60310183) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0013340) |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2019-01-30 |