| NPI | 1104391085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: GA PHTC066137) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy |
| Enumeration Date | 2018-10-08 |
| Last Update Date | 2025-09-11 |