| NPI | 1720663883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61156144) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 61756) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2024-01-16 |