| NPI | 1609601004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61542835) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 126208) |
| Enumeration Date | 2024-09-05 |
| Last Update Date | 2024-09-05 |