| NPI | 1538980669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: CA 17440000X) |
| 376G00000X Nursing Home Administrator (Licence: CA 174400000X) | |
| Enumeration Date | 2024-10-22 |
| Last Update Date | 2024-10-22 |