| NPI | 1881404010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA 61068869) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 61068869) |
| Enumeration Date | 2025-01-09 |
| Last Update Date | 2025-01-09 |