| NPI | 1053044792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 39675) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 39675) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2022-07-08 |