| NPI | 1215578836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 65686) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61168149) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2025-10-13 |