| NPI | 1790802593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: MT 10995) |
| Additional Taxonomies | 174400000X Specialist |
| 376J00000X Homemaker | |
| Enumeration Date | 2007-03-25 |
| Last Update Date | 2025-02-24 |