| NPI | 1760850366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60655046) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 60281504) |
| Enumeration Date | 2015-09-13 |
| Last Update Date | 2023-08-23 |