| NPI | 1689479628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH rv442166) |
| Additional Taxonomies | 253Z00000X In Home Supportive Care (Licence: OH rv442166) |
| 310400000X Assisted Living Facility (Licence: OH rv442166) | |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: OH rv442166) | |
| Enumeration Date | 2025-02-14 |
| Last Update Date | 2025-02-14 |