| NPI | 1003294604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: FL VM12748) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: TX 10569) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2015-05-14 |