| NPI | 1043813777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker (Licence: OH 7718984) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: OH 7718984) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-11-17 |