| NPI | 1720562309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03438557) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60860238) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2020-12-02 |