| NPI | 1063122851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347C00000X Private Vehicle (Licence: FL A352-512-92-426-0) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: FL A352-512-92-426-0) |
| Enumeration Date | 2022-12-02 |
| Last Update Date | 2022-12-02 |