| NPI | 1720416043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 311ZA0620X Custodial Care Facility, Adult Care Home (Licence: NC FCL-032-132) |
| Additional Taxonomies | 320700000X Residential Treatment Facility, Physical Disabilities (Licence: NC FCL-032-132) |
| 376G00000X Nursing Home Administrator (Licence: NC FCL-032-132) | |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2014-04-02 |