| NPI | 1275129793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: OR CPT-0012541) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: WA VA61112817) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2020-12-18 |