| NPI | 1962390997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376G00000X Nursing Home Administrator (Licence: NE H12270555) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: NE H12270555) |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-06-26 |