| NPI | 1649771924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60741616) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0016526) |
| Enumeration Date | 2018-02-22 |
| Last Update Date | 2018-02-22 |