| NPI | 1811690035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 73768) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: TX 43550) |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2024-03-08 |