| NPI | 1609441351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60844394) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 62183) |
| Enumeration Date | 2021-05-25 |
| Last Update Date | 2021-07-15 |