| NPI | 1356890727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 178619-030) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: 178619-030) |
| Enumeration Date | 2016-09-27 |
| Last Update Date | 2016-09-27 |