| NPI | 1275941072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH 00052297) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT 4849PHA) |
| 183500000X Pharmacist (Licence: WA PH00052297) | |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2022-06-02 |