| NPI | 1053942904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 172A00000X Driver |
| 251E00000X Home Health | |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2020-01-30 |