| NPI | 1891460739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61355356) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 30754) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2023-02-07 |