| NPI | 1295013498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: MN 04713) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: CO 8059) |
| 174M00000X Veterinarian (Licence: CA 16574) | |
| 174M00000X Veterinarian (Licence: VA 0301201666) | |
| Enumeration Date | 2011-07-22 |
| Last Update Date | 2014-12-23 |