| NPI | 1528834082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 253Z00000X In Home Supportive Care (Licence: MI 1619752334) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: MI 1619752334) |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |