| NPI | 1861764755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: CO VET.0009826) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: IL 090010422) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2013-07-10 |