| NPI | 1013473255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376G00000X Nursing Home Administrator (Licence: NY 05809) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: MA NH5488) |
| 376G00000X Nursing Home Administrator (Licence: NJ 3143) | |
| Enumeration Date | 2019-02-12 |
| Last Update Date | 2019-02-12 |