| NPI | 1649756453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60872245) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202216042) |
| Enumeration Date | 2018-07-15 |
| Last Update Date | 2022-01-18 |