| NPI | 1134467343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID p5758) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60600882) |
| Enumeration Date | 2013-01-22 |
| Last Update Date | 2024-01-16 |