| NPI | 1780192104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60860921) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA IR60483916) |
| Enumeration Date | 2018-01-19 |
| Last Update Date | 2018-08-23 |