| NPI | 1902076599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376G00000X Nursing Home Administrator (Licence: CO NHA2278) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CO PN2278) |
| Enumeration Date | 2008-03-10 |
| Last Update Date | 2008-03-10 |