| NPI | 1013638014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 61326188) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0019101) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2022-09-07 |