| NPI | 1205602331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI04316200) |
| 183500000X Pharmacist (Licence: MI 5302415500) | |
| Enumeration Date | 2023-11-29 |
| Last Update Date | 2025-10-17 |