| NPI | 1154719292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347E00000X Transportation Broker (Licence: NY 296704) |
| Additional Taxonomies | 251B00000X Case Management (Licence: NY 296704) |
| 251J00000X Nursing Care (Licence: NY 296704) | |
| 302R00000X Health Maintenance Organization (Licence: NY 296704) | |
| 332U00000X Home Delivered Meals (Licence: NY 296704) | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2017-10-03 |