| NPI | 1942072426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AZ AL12794H) |
| Additional Taxonomies | 374U00000X Home Health Aide (Licence: AZ T3081122) |
| Enumeration Date | 2023-10-26 |
| Last Update Date | 2024-09-30 |