| NPI | 1063819803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WI 9247-123) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 10063-40) |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2019-11-07 |