| NPI | 1780352526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: AZ BH8372) |
| Additional Taxonomies | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness (Licence: AZ AL11941H) |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2023-06-15 |