| NPI | 1710357421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: PA BV012482) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: NJ 29VI00668200) |
| 174M00000X Veterinarian (Licence: DE N1-0002713) | |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2015-10-07 |