| NPI | 1790158822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60876415) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 60494150) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2018-10-02 |