| NPI | 1194369264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA PLC9826) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| 347E00000X Transportation Broker | |
| Enumeration Date | 2019-11-01 |
| Last Update Date | 2023-09-29 |