| NPI | 1710301239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60464690) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60464690) |
| Enumeration Date | 2014-02-05 |
| Last Update Date | 2019-04-17 |