| NPI | 1528677507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: WA VA-60988386) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: OR CPT-0012227) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2020-07-27 |