| NPI | 1023443538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: NY 002917) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: NJ D00393500) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2013-09-04 |