| NPI | 1457805186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TN 1036) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: CA OTA 2139) |
| Enumeration Date | 2016-08-11 |
| Last Update Date | 2016-08-11 |