| NPI | 1245947621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347C00000X Private Vehicle (Licence: NC 32772190) |
| Additional Taxonomies | 172A00000X Driver (Licence: NC 32772190) |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: NC 32772190) | |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2025-02-20 |