| NPI | 1649120700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA PI129431) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: PA 30305910) |
| 183700000X Pharmacy Technician (Licence: PA PTE002436) | |
| Enumeration Date | 2026-01-29 |
| Last Update Date | 2026-06-03 |