| NPI | 1366962003 |
|---|---|
| Other Name | NONE NONE NONE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: KS 036-820900399F-01) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2017-06-23 |