| NPI | 1508201286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: NJ 20VI00608600) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: PA BV012813) |
| Enumeration Date | 2013-05-08 |
| Last Update Date | 2013-05-08 |