| NPI | 1942865118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60868668) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P8307) |
| Enumeration Date | 2019-05-03 |
| Last Update Date | 2019-05-03 |