| NPI | 1962152157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 022894) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KY I14023) |
| Enumeration Date | 2022-03-28 |
| Last Update Date | 2022-07-13 |