| NPI | 1710742887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: CA 366424426) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: 366424426) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-02-19 |