| NPI | 1811620792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60667890) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P8075) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2022-07-07 |