| NPI | 1740419225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: FL PTA20203) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: FL pta20203) |
| 376G00000X Nursing Home Administrator (Licence: FL NH4843) | |
| Enumeration Date | 2009-07-06 |
| Last Update Date | 2024-09-20 |