| NPI | 1235806027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: LA 82-1264661) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: LA 007709423) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2021-08-27 |