| NPI | 1366044547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: FL 12776) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: FL 12776) |
| Enumeration Date | 2020-11-12 |
| Last Update Date | 2020-11-12 |