| NPI | 1689302887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 23048) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61434840) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2025-03-09 |