| NPI | 1720663156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH61181344) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WY N4467) |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2025-12-11 |