| NPI | 1174127260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: OH 7718054) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: OH 7718054) |
| 374U00000X Home Health Aide (Licence: OH 7718054) | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2020-11-30 |