| NPI | 1609658251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances |
| Additional Taxonomies | 253Z00000X In Home Supportive Care |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-10-18 |