| NPI | 1356514145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: OR T-0011752) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: WA VA00057147) |
| Enumeration Date | 2008-04-11 |
| Last Update Date | 2008-04-11 |