| NPI | 1982627774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care (Licence: FL ME51410) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: FL ME51410) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2014-01-29 |