| NPI | 1194058875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347B00000X Bus (Licence: TX 05501680) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: TX 05501680) |
| Enumeration Date | 2009-09-11 |
| Last Update Date | 2009-09-11 |