| NPI | 1669846648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: VA 0002082700) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: VA 0002082700) |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2015-11-13 |