| NPI | 1619369824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: IL 090.011197) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: KY NS-4795) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2015-02-25 |