| NPI | 1235563362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP455185) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 27492) |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2013-08-26 |
| Last Update Date | 2021-01-27 |