| NPI | 1366812745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122276) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN 122276) |
| Enumeration Date | 2015-09-29 |
| Last Update Date | 2015-09-29 |