| NPI | 1023370194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343800000X Secured Medical Transport (VAN) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 387111) |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2012-06-13 |