| NPI | 1811478951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 374T00000X Religious Nonmedical Nursing Personnel |
| Additional Taxonomies | 376G00000X Nursing Home Administrator |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2018-08-27 |