| NPI | 1689337644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61341288) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2021034115) |
| 183500000X Pharmacist (Licence: KS 1-103678) | |
| Enumeration Date | 2021-10-18 |
| Last Update Date | 2022-12-27 |