| NPI | 1780957571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0012750) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 60232663) |
| Enumeration Date | 2012-02-09 |
| Last Update Date | 2015-10-08 |