| NPI | 1982154522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 9400) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA ph 60065243) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-10-06 |