| NPI | 1811455587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60700503) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MS E-14472) |
| 183500000X Pharmacist (Licence: OR RPH-0016138) | |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2023-06-14 |