| NPI | 1699167734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60371570) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 9053397-1701) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2019-09-30 |