| NPI | 1700908035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60126440) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0010288) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2025-10-05 |