| NPI | 1992594873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: WA VA61685686) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: OR CPT-0015544) |
| Enumeration Date | 2025-05-06 |
| Last Update Date | 2025-05-06 |