| NPI | 1548724727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: NV NVN118AGC) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: NV 3742-AGC-18) |
| 310400000X Assisted Living Facility (Licence: NV 119-AGC-26) | |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2020-03-31 |