| NPI | 1295936219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL 10478) |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: FL 10478) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-09 |