| NPI | 1952871063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60889426) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 20012) |
| Enumeration Date | 2018-12-01 |
| Last Update Date | 2018-12-01 |