| NPI | 1497318182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376G00000X Nursing Home Administrator |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MD LP51025) |
| Enumeration Date | 2019-04-17 |
| Last Update Date | 2021-04-06 |