| NPI | 1083990220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP445592) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 174H00000X Health Educator | |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2022-07-21 |