| NPI | 1295417442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: CO 13-134-0594) |
| Additional Taxonomies | 172A00000X Driver (Licence: CO 13-134-0594) |
| 172A00000X Driver | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2023-08-07 |
| Last Update Date | 2023-08-07 |