| NPI | 1306286885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 121244) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2020-05-28 |