| NPI | 1366196578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility Adult Care Home |
| Additional Taxonomies | 372600000X Adult Companion |
| 376J00000X Homemaker | |
| Enumeration Date | 2022-02-07 |
| Last Update Date | 2022-02-07 |