| NPI | 1144489865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: AL 5517) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: KY NS-KY-4060) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2008-06-06 |