| NPI | 1184060287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: KY NS-KY-2479) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: TN DV0000002873) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2013-05-15 |