| NPI | 1104240837 |
|---|---|
| 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 058995) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2025-07-24 |