| NPI | 1619793015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 385HR2060X Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child |
| Additional Taxonomies | 172A00000X Driver (Licence: OH UR685742) |
| 347C00000X Private Vehicle (Licence: OH UR685742) | |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2024-12-02 |