| NPI | 1558903088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376J00000X Homemaker (Licence: AZ AL5663H) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: AZ AL5663H) |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2019-10-16 |