| NPI | 1255513800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: CO 7972) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: KS 6725) |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2007-12-05 |