| NPI | 1194280404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: LA 006138892) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: LA 006138892) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2019-10-09 |