| NPI | 1043970320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: MI AS410311728) |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: MI AS410409367) |
| Enumeration Date | 2021-12-28 |
| Last Update Date | 2021-12-30 |