| NPI | 1730574112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL PH27278) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S10789) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-04-20 |