| NPI | 1720831324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310500000X Intermediate Care Facility, Mental Illness (Licence: SC 2292) |
| Additional Taxonomies | 310400000X Assisted Living Facility (Licence: SC 2292) |
| Enumeration Date | 2024-04-11 |
| Last Update Date | 2024-04-11 |