| NPI | 1245723220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AZ AL10708H) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: AZ 10708) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2018-06-13 |