| NPI | 1942631783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 70335) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60406475) |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2020-10-05 |