| NPI | 1740578673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60259533) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0012864) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2020-07-23 |