| NPI | 1699305110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 22461) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S12666) |
| Enumeration Date | 2020-01-23 |
| Last Update Date | 2022-06-26 |