| NPI | 1932810298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: WA VA61179821) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA VA61179821) |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2022-12-19 |