| NPI | 1124346671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 014475) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY 014475) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2010-10-22 |