| NPI | 1740528918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH 401316011111) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: OH 401316011111) |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2025-07-06 |