| NPI | 1386151660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302411978) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 183700000X Pharmacy Technician | |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2019-08-21 |