| NPI | 1508295411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: NY 005182) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: FL 0003580) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2013-11-01 |