| NPI | 1487253860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AZ AL11467H) |
| Additional Taxonomies | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness | |
| Enumeration Date | 2020-10-18 |
| Last Update Date | 2020-10-18 |