| NPI | 1578967287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: CT 10050720) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: CT 0012497) |
| Enumeration Date | 2014-10-09 |
| Last Update Date | 2014-10-09 |