| NPI | 1659688281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: TX 2065916) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: MS PTA 1424) |
| Enumeration Date | 2010-09-02 |
| Last Update Date | 2010-09-02 |