| NPI | 1578904132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 21047) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PSI28323) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2022-07-21 |