| NPI | 1700261112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 311Z00000X Custodial Care Facility |
| 310400000X Assisted Living Facility | |
| Enumeration Date | 2015-07-27 |
| Last Update Date | 2025-01-29 |