| NPI | 1235664863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: WA VA60776216) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA VB 60710424) |
| Enumeration Date | 2017-04-20 |
| Last Update Date | 2021-06-28 |