| NPI | 1528831997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH RQ953947) |
| Additional Taxonomies | 261QA0600X Clinic/Center, Adult Day Care (Licence: OH RQ953947) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2023-11-06 |