| NPI | 1255805735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PS64702) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60872477) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2024-04-18 |