| NPI | 1619419371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60917850) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 21501) |
| Enumeration Date | 2016-11-12 |
| Last Update Date | 2019-07-09 |