| NPI | 1649402298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH CMS) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OH QMHS) |
| 183500000X Pharmacist (Licence: OH 03-3-19961) | |
| 1835P0018X Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist (Licence: KY 015321) | |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2019-12-09 |