| NPI | 1649874751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL PSI39341) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: FL PSI39341) |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2020-11-30 |