| NPI | 1174096242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 62303) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: CA 62303) |
| 1835X0200X Pharmacist, Oncology (Licence: CA 62303) | |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2019-01-10 |