| NPI | 1508347782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: CA 342700186) |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2018-08-27 |