| NPI | 1861178170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH TN391370) |
| Additional Taxonomies | 3747P1801X Technician, Personal Care Attendant (Licence: OH TN391370) |
| Enumeration Date | 2023-06-22 |
| Last Update Date | 2023-06-22 |