| NPI | 1245959014 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: 30014713) | 
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: TX 274381) | 
| Enumeration Date | 2022-08-25 | 
| Last Update Date | 2022-08-25 |