| NPI | 1528421161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: SC CRC1529) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: SC CRC1529) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2016-03-31 |