| NPI | 1639912876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61458624) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P10870) |
| Enumeration Date | 2024-06-17 |
| Last Update Date | 2024-06-17 |