| NPI | 1295002962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60680447) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA 61133) |
| Enumeration Date | 2011-11-23 |
| Last Update Date | 2025-05-15 |