| NPI | 1316102833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: NH 14859) |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: MA 244893) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2021-11-03 |