| NPI | 1770876294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: LA 1229) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: TX 4530) |
| Enumeration Date | 2011-05-17 |
| Last Update Date | 2011-05-17 |