| NPI | 1174976054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0021786) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 18562-40) |
| 183500000X Pharmacist (Licence: WA PH60774694) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 8069) | |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2023-09-18 |