| NPI | 1366906752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60971675) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: WA PH60971675) |
| Enumeration Date | 2019-01-30 |
| Last Update Date | 2025-09-08 |