| NPI | 1417576968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0017832) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61068367) |
| Enumeration Date | 2020-04-15 |
| Last Update Date | 2025-03-03 |