| NPI | 1891391058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WV RP0005267) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: WV 20520130) |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2020-12-11 |