| NPI | 1316332315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 374T00000X Religious Nonmedical Nursing Personnel |
| Additional Taxonomies | 376G00000X Nursing Home Administrator |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2015-04-06 |