| NPI | 1437746096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker (Licence: OH 0000258076) |
| Additional Taxonomies | 172A00000X Driver (Licence: OH TE870584) |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2020-12-29 |