| NPI | 1215528948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: MI 5303018960) |
| Additional Taxonomies | 183700000X Pharmacy Technician |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2021-01-26 |
| Last Update Date | 2021-01-26 |