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