| NPI | 1952896615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7115188-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ir60836298) |
| 183500000X Pharmacist (Licence: WA PH60856689) | |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2021-04-13 |