NPI | 1063716488 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 174M00000X Veterinarian (Licence: VA 0301202833) |
Additional Taxonomies | 174400000X Specialist (Licence: NJ 29VI00782900) |
174M00000X Veterinarian (Licence: MD 6708) | |
Enumeration Date | 2010-12-28 |
Last Update Date | 2019-09-18 |