| NPI | 1619455045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA.0023445) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME PI45594) |
| Enumeration Date | 2018-07-28 |
| Last Update Date | 2023-11-17 |