| NPI | 1598139743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| 311Z00000X Custodial Care Facility | |
| Enumeration Date | 2015-11-25 |
| Last Update Date | 2015-11-25 |