| NPI | 1114494465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302412014) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5302043705) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2020-01-03 |