| NPI | 1003264714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility |
| Additional Taxonomies | 171W00000X Contractor |
| 305S00000X Point of Service | |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2016-06-03 |