| NPI | 1861250540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AZ AL10469) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: AZ AL10469) |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2024-03-07 |