| NPI | 1811321045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP447737) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 174H00000X Health Educator | |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: DC 3162979) | |
| Enumeration Date | 2013-08-23 |
| Last Update Date | 2020-11-25 |