| NPI | 1205520558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61447744) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA IR60995071) |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2024-09-04 |