| NPI | 1295093086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376G00000X Nursing Home Administrator (Licence: GA NIIA005224) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: GA LPN052272) |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2012-04-30 |