| NPI | 1134588379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: ME ALLS-6306) |
| Additional Taxonomies | 311Z00000X Custodial Care Facility (Licence: ME ALLS-6306) |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: ME ALLS-6306) | |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2016-02-16 |