| NPI | 1306341326 |
|---|---|
| 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: TX 67442) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2022-06-21 |