| NPI | 1659795342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 66710) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60120621) |
| 1835G0303X Pharmacist, Geriatric (Licence: CA 66710) | |
| Enumeration Date | 2014-02-14 |
| Last Update Date | 2020-04-04 |