| NPI | 1972187581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: CA 306005651) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CA 306005651) |
| 3104A0630X Assisted Living Facility, Assisted Living, Behavioral Disturbances (Licence: CA 306005651) | |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2021-05-10 |