| NPI | 1487311015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OH 03442326) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PSI39106) |
| Enumeration Date | 2021-11-18 |
| Last Update Date | 2022-08-11 |