| NPI | 1174951487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 69904) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60393198) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2026-05-11 |