| NPI | 1164858080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: NY 004692-1) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: MI 6901005527) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2013-09-24 |