| 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 |