| NPI | 1740718725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60672106) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-39576) |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2017-06-02 |