| NPI | 1881979391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: AZ 6239) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: WA VT 60014477) |
| 174M00000X Veterinarian (Licence: OR 6824) | |
| Enumeration Date | 2011-10-15 |
| Last Update Date | 2013-08-18 |