| NPI | 1043680309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: NY 168607416) |
| Additional Taxonomies | 172A00000X Driver (Licence: NY 168607416) |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-09-30 |