| NPI | 1972938447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P9038) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61631531) |
| 183500000X Pharmacist (Licence: ME PR12594) | |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2025-10-13 |