| NPI | 1194328781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: KY PT00356430) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: OH G4W7R3S6) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |