| NPI | 1164038865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: TX 257446) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2025-04-11 |