| NPI | 1922443878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 19349) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: AL S10678) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2020-10-27 |