| NPI | 1144044488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH70007545) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID 7171175) |
| Enumeration Date | 2024-11-13 |
| Last Update Date | 2026-01-11 |