NPI | 1902654403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: AZ BH9696) |
Additional Taxonomies | 385H00000X Respite Care (Licence: AZ BH9696) |
Enumeration Date | 2024-05-09 |
Last Update Date | 2024-05-09 |