| NPI | 1174097620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 69164) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S12374) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2021-11-08 |