| NPI | 1255806360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA 3021343) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA PH60864581) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2026-06-10 |