| NPI | 1013291244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 146D00000X Personal Emergency Response Attendant (Licence: OH 50003364) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OH 50.003364RX) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2016-01-26 |