| NPI | 1720621923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61053398) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA IR60669674) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2020-09-18 |