| NPI | 1093355224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: TX 166837) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: ID CT61906) |
| 183700000X Pharmacy Technician (Licence: CO PHAT.0019006) | |
| Enumeration Date | 2020-01-15 |
| Last Update Date | 2025-06-30 |