| NPI | 1295297018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OR RPH-0016181) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60780826) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2022-07-22 |