| NPI | 1972127843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302415557) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5303018068) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 5351016280) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: NE 9672) | |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2023-09-15 |