| NPI | 1336958453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: MO 2024037403) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: MO 19331) |
| Enumeration Date | 2025-01-03 |
| Last Update Date | 2026-04-07 |