| NPI | 1669276341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WA 435600) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WA 649300) |
| 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: WA 520702) | |
| Enumeration Date | 2025-04-02 |
| Last Update Date | 2025-04-02 |