| NPI | 1831349919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OR RPH-0017197) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: HI RN63082) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2021-04-12 |