| NPI | 1235610486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: PR 10836) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 2855) |
| Enumeration Date | 2018-08-26 |
| Last Update Date | 2026-02-17 |