| NPI | 1093038960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 503304) |
| Enumeration Date | 2010-03-08 |
| Last Update Date | 2021-03-25 |