| NPI | 1699928564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: SC CRC-240) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: SC CRC-538) |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2008-10-23 |