| NPI | 1548592140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH00054809) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5782) |
| Enumeration Date | 2010-02-05 |
| Last Update Date | 2023-01-24 |