| NPI | 1518431063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 43368) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S12445) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2022-03-21 |