| NPI | 1164122198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: OH 4895079) |
| Enumeration Date | 2023-03-08 |
| Last Update Date | 2023-03-08 |