| NPI | 1215825633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: MN 738430) |
| Additional Taxonomies | 3336C0003X Pharmacy, Community/Retail Pharmacy (Licence: MN 738430) |
| Enumeration Date | 2025-06-25 |
| Last Update Date | 2025-06-25 |