| NPI | 1588971220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60574295) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-16173) |
| Enumeration Date | 2010-09-01 |
| Last Update Date | 2022-10-26 |