| NPI | 1871257162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR RPH-0018684) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH61190496) |
| Enumeration Date | 2021-10-24 |
| Last Update Date | 2023-02-17 |