| NPI | 1902189095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60170840) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60507700) |
| Enumeration Date | 2011-09-24 |
| Last Update Date | 2020-02-27 |