| NPI | 1538611793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: OR CPT-0010020) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: FL RPT47760) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2016-11-03 |