| NPI | 1750664496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 101078) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 28703) |
| Enumeration Date | 2011-09-20 |
| Last Update Date | 2024-09-17 |