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 |