| NPI | 1871993261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 059827) |
| Additional Taxonomies | 1835X0200X Pharmacist, Oncology (Licence: NY 059827) |
| Enumeration Date | 2014-09-04 |
| Last Update Date | 2015-05-07 |