| NPI | 1184902157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 372600000X Adult Companion | |
| 251E00000X Home Health (Licence: FL 007902900) | |
| 251E00000X Home Health (Licence: FL 003905100) | |
| 376J00000X Homemaker (Licence: FL 232909) | |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2016-02-10 |