| NPI | 1164765194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: TX LHOC1200349) |
| Additional Taxonomies | 343800000X Secured Medical Transport (VAN) |
| Enumeration Date | 2013-03-28 |
| Last Update Date | 2025-09-19 |