| NPI | 1972156669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61330362) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17999) |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2023-05-12 |