| NPI | 1336925171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver |
| Additional Taxonomies | 251C00000X Day Training, Developmentally Disabled Services |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 347C00000X Private Vehicle | |
| 376J00000X Homemaker | |
| Enumeration Date | 2023-09-07 |
| Last Update Date | 2023-12-02 |