| NPI | 1326717414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 90783) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61176615) |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2025-07-01 |