| NPI | 1902032493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3104A0625X Assisted Living Facility, Assisted Living, Mental Illness |
| Additional Taxonomies | 225200000X Physical Therapy Assistant |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2009-06-10 |