| NPI | 1487837381 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: UT 352596-4202) |
| Additional Taxonomies | 251E00000X Home Health (Licence: UT 352596-4202) |
| Enumeration Date | 2007-12-13 |
| Last Update Date | 2007-12-13 |