| NPI | 1447973136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 251E00000X Home Health |
| 310400000X Assisted Living Facility | |
| Enumeration Date | 2022-09-19 |
| Last Update Date | 2023-04-10 |