| NPI | 1659896686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60758033) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND RPh5962) |
| Enumeration Date | 2017-08-10 |
| Last Update Date | 2017-08-10 |