| NPI | 1164795373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 125.079312) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: IL 049181709) |
| Enumeration Date | 2012-02-18 |
| Last Update Date | 2022-04-19 |