| NPI | 1699298760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60884534) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 60468409) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2020-04-08 |