| NPI | 1104697515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: OH ru483376) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OH ru483376) |
| 171WH0202X Contractor, Home Modifications (Licence: OH ru483376) | |
| 172A00000X Driver (Licence: OH ru483376) | |
| 347C00000X Private Vehicle (Licence: OH ru483376) | |
| Enumeration Date | 2024-01-15 |
| Last Update Date | 2024-01-15 |