| NPI | 1710683768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: MD T27329) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: PA 1073843) |
| Enumeration Date | 2023-02-01 |
| Last Update Date | 2025-08-20 |