| NPI | 1700516986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL LPC05074) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: AL T21263) |
| Enumeration Date | 2022-06-12 |
| Last Update Date | 2023-11-13 |