| NPI | 1700350253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 21957) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S12376) |
| Enumeration Date | 2019-01-17 |
| Last Update Date | 2021-10-16 |