| NPI | 1649857855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 75163) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 41104) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2024-12-11 |