| NPI | 1558964585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: WA PH61066433) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy |
| Enumeration Date | 2020-11-20 |
| Last Update Date | 2024-07-23 |