| NPI | 1780405852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH RT390668) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH RT390668) |
| 101YM0800X Counselor, Mental Health (Licence: OH RT390668) | |
| 171W00000X Contractor (Licence: OH RT390668) | |
| 261QA0600X Clinic/Center, Adult Day Care | |
| 3747P1801X Technician, Personal Care Attendant (Licence: OH RT390668) | |
| Enumeration Date | 2024-10-22 |
| Last Update Date | 2024-11-18 |