| NPI | 1306716980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH RN651646) |
| Additional Taxonomies | 376J00000X Homemaker |
| 3747P1801X Technician, Personal Care Attendant | |
| Enumeration Date | 2025-11-07 |
| Last Update Date | 2025-11-10 |