| NPI | 1568869949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0014222) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH 60475155) |
| Enumeration Date | 2014-12-01 |
| Last Update Date | 2026-07-06 |