| NPI | 1104201631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IA 01591) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2015-07-27 |