| NPI | 1104789874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 172A00000X Driver |
| 347E00000X Transportation Broker | |
| Enumeration Date | 2025-12-08 |
| Last Update Date | 2025-12-08 |