| NPI | 1104518810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0015800) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60660128) |
| Enumeration Date | 2023-05-22 |
| Last Update Date | 2023-05-22 |