| NPI | 1104190495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: WA PHRM.PH00019445) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 194445) |
| Enumeration Date | 2012-03-04 |
| Last Update Date | 2026-05-27 |