| NPI | 1063921724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AR 511) |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: AR 511) |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2017-10-04 |