| NPI | 1942802574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker (Licence: OH 4810171) |
| Additional Taxonomies | 376J00000X Homemaker |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2020-11-09 |
| Last Update Date | 2023-01-17 |