| NPI | 1982157533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 29632) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: DC HHA12304) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2024-01-12 |