| NPI | 1215434576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347C00000X Private Vehicle (Licence: LA 008810870) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: LA 008810870) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2018-04-11 |