| NPI | 1134705585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: WV PT0010763) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: VA 0230037671) |
| Enumeration Date | 2021-03-23 |
| Last Update Date | 2023-08-14 |