| NPI | 1780081372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH033470.) |
| Additional Taxonomies | 171W00000X Contractor (Licence: DC HHA10649) |
| 374U00000X Home Health Aide (Licence: DC HHA10649) | |
| Enumeration Date | 2014-11-25 |
| Last Update Date | 2021-12-14 |