| NPI | 1598063901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 8088085-8911) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2025-12-28 |