| NPI | 1003162843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 60280218) |
| Additional Taxonomies | 1835N1003X Pharmacist, Nutrition Support (Licence: WA PH60280218) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2024-11-12 |