| NPI | 1205545019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 172A00000X Driver |
| 372600000X Adult Companion (Licence: OH 3726000000x) | |
| Enumeration Date | 2022-11-21 |
| Last Update Date | 2022-11-21 |