| NPI | 1275163784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S12648) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AL 22862) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PSI40195) | |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2024-01-13 |