| NPI | 1811373822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH0015131) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60483812) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2025-05-20 |