| NPI | 1205302783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: VA 723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001243079) |
| Enumeration Date | 2018-10-22 |
| Last Update Date | 2018-12-21 |