| NPI | 1629557871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60868664) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P8396) |
| Enumeration Date | 2018-08-08 |
| Last Update Date | 2021-02-04 |