| NPI | 1760106611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AZ AL12291H) |
| Additional Taxonomies | 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances (Licence: AZ AL12291H) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-10-03 |