| NPI | 1083404248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343800000X Secured Medical Transport (VAN) |
| Additional Taxonomies | 171W00000X Contractor |
| 172A00000X Driver | |
| 342000000X Transportation Network Company | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2025-05-10 |
| Last Update Date | 2025-07-03 |