| NPI | 1467082974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA PST.024475) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S12706) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2022-09-18 |