| NPI | 1710195730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: WA ph00011024) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH00011024) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2025-09-11 |