| NPI | 1700307907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100003058) |
| Additional Taxonomies | 183700000X Pharmacy Technician |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-06-28 |
| Last Update Date | 2018-01-19 |