| NPI | 1114543816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: 250100103030555) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: WV PT0008013) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2020-06-22 |