| NPI | 1760959548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183700000X Pharmacy Technician (Licence: FL RPT29546) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral (Licence: FL 7654321) |
| 251E00000X Home Health (Licence: FL RPT29546) | |
| Enumeration Date | 2018-10-30 |
| Last Update Date | 2018-10-30 |