| NPI | 1669254900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61452384) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P11099) |
| Enumeration Date | 2023-10-20 |
| Last Update Date | 2024-07-23 |