| NPI | 1881730679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: NY 300100104111250) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2019-01-23 |