| NPI | 1326507674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347C00000X Private Vehicle |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| 347B00000X Bus | |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2019-03-17 |