| NPI | 1609125244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60289591) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P6646) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2025-01-27 |