| NPI | 1487242400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH RQ788849) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant |
| 376J00000X Homemaker | |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2021-01-05 |