| NPI | 1124422050 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: SC 39364) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 15351) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2022-03-16 |