| NPI | 1013646264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: TX 48585475) |
| Additional Taxonomies | 172A00000X Driver (Licence: NY 940870283) |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: 48585475) | |
| Enumeration Date | 2022-06-05 |
| Last Update Date | 2023-03-02 |