| NPI | 1396102208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347C00000X Private Vehicle (Licence: NY 368638889) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: NY 368638889) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2016-01-22 |