| NPI | 1053703447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747P1801X Technician, Personal Care Attendant |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: MN 12223645000027) |
| Enumeration Date | 2015-02-23 |
| Last Update Date | 2023-08-21 |