| NPI | 1952182180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Additional Taxonomies | 313M00000X Nursing Facility/Intermediate Care Facility |
| 315D00000X Hospice, Inpatient | |
| Enumeration Date | 2023-10-12 |
| Last Update Date | 2023-10-14 |