| NPI | 1801335435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376K00000X Nurse's Aide (Licence: PR 14797) |
| Additional Taxonomies | 376G00000X Nursing Home Administrator (Licence: PR 14797) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2017-02-15 |