| NPI | 1295160836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5151015914) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302037090) |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2022-07-10 |