| NPI | 1164231122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: MI 5303049585) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2025-01-04 |
| Last Update Date | 2025-09-10 |