| NPI | 1659032944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: MI 5303039917) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: p041184) |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2022-01-07 |