| NPI | 1659048346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60864246) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI PH60864246) |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2021-09-14 |