| NPI | 1871918359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 066221) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PSI 28740) |
| Enumeration Date | 2014-02-20 |
| Last Update Date | 2023-03-14 |