| NPI | 1518402759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA MT220009) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP450845) |
| Enumeration Date | 2016-12-26 |
| Last Update Date | 2026-04-22 |