| NPI | 1114585163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 171W00000X Contractor (Licence: ID RCT47478) |
| 171WH0202X Contractor, Home Modifications (Licence: ID RCT47478) | |
| 172A00000X Driver | |
| 251B00000X Case Management | |
| 347C00000X Private Vehicle | |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2019-06-26 |