| NPI | 1790231280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: WA PH60481994) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60481994) |
| Enumeration Date | 2016-08-25 |
| Last Update Date | 2019-04-29 |