| NPI | 1427555697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60849077) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS54482) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2026-04-23 |