| NPI | 1609399690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61066856) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: WA PH61066856) |
| 1835P2201X Pharmacist Ambulatory Care (Licence: WA PH61066856) | |
| Enumeration Date | 2017-07-21 |
| Last Update Date | 2021-07-20 |