| NPI | 1922378454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174M00000X Veterinarian (Licence: MT 1297) |
| Additional Taxonomies | 174M00000X Veterinarian (Licence: IL 090.005719) |
| Enumeration Date | 2011-12-30 |
| Last Update Date | 2011-12-30 |