| NPI | 1750057899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 067957) |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2026-08-11 |