| NPI | 1689077208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: CA 6704) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: MT 901) |
| 174M00000X Veterinarian (Licence: MN 12714) | |
| Enumeration Date | 2014-09-28 |
| Last Update Date | 2014-09-28 |