| NPI | 1548765001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: 530107010139982) |
| Additional Taxonomies | 3336I0012X Pharmacy, Institutional Pharmacy (Licence: 530107010139982) |
| 3336M0003X Pharmacy, Managed Care Organization Pharmacy (Licence: 530107010139982) | |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2018-03-27 |