| NPI | 1427756881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AZ AL9563H) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: AZ AL11979H) |
| Enumeration Date | 2023-02-15 |
| Last Update Date | 2023-02-15 |