| NPI | 1588107338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61100246) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA IR60602871) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2022-02-04 |