| NPI | 1528404738 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: WA Ph60631590)  | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ s017054)  | 
| Enumeration Date | 2013-05-14 | 
| Last Update Date | 2020-01-27 |