| NPI | 1538935101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-28 |