| NPI | 1508022054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: TN ot0000003111) |
| Additional Taxonomies | 225X00000X Occupational Therapist |
| Enumeration Date | 2008-08-04 |
| Last Update Date | 2023-11-16 |