| NPI | 1114416153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251J00000X Nursing Care |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TX 956556) |
| 310400000X Assisted Living Facility | |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances | |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2018-05-04 |
| Last Update Date | 2025-07-02 |