| NPI | 1629792668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: OR CPT-0009066) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: WA VA60433526) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-10-03 |