| NPI | 1275427700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH70012522) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR61180377) |
| Enumeration Date | 2025-06-09 |
| Last Update Date | 2026-06-06 |