| NPI | 1104465137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347E00000X Transportation Broker |
| Additional Taxonomies | 343800000X Secured Medical Transport (VAN) |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2019-12-20 |