| NPI | 1265825459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: AR PT08459) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MI 5303001032) |
| 183700000X Pharmacy Technician (Licence: FL RPT78963) | |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2018-08-23 |