| NPI | 1912208422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ s024282) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00039921) |
| Enumeration Date | 2010-11-15 |
| Last Update Date | 2020-11-10 |