| NPI | 1023465556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AZ I012368) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME PI13145) |
| 183500000X Pharmacist (Licence: AZ S022180) | |
| Enumeration Date | 2016-05-13 |
| Last Update Date | 2016-09-24 |