| NPI | 1689035834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60583390) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH0014884) |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2022-06-09 |