| NPI | 1902242282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: KY NS-877) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: UT 7416249-2801) |
| 174M00000X Veterinarian (Licence: OH VET 3672) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2013-05-14 |