| NPI | 1952995086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities (Licence: CA 331881116) |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility Adult Care Home |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-16 |