| NPI | 1972465730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH70000890) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0020739) |
| Enumeration Date | 2025-12-01 |
| Last Update Date | 2025-12-01 |