| NPI | 1689544827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: NC 1972478592) |
| Additional Taxonomies | 3336L0003X Pharmacy, Long Term Care Pharmacy (Licence: NC 1972478592) |
| Enumeration Date | 2025-11-11 |
| Last Update Date | 2025-11-12 |