| NPI | 1700133626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00017815) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID p4869) |
| 183500000X Pharmacist (Licence: MT 3318) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2023-09-26 |