| NPI | 1881903011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH0053415) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: CO CO16414) |
| Enumeration Date | 2010-10-05 |
| Last Update Date | 2020-07-16 |