| NPI | 1922412261 |
|---|---|
| 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: MD 20961) |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2026-03-27 |