| NPI | 1710918602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA P67961) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA IR00053226) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2008-05-21 |