| NPI | 1487938106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: FL VM 11498) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: MA VT 2535) |
| Enumeration Date | 2011-09-29 |
| Last Update Date | 2011-09-29 |