| NPI | 1417566670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 172A00000X Driver (Licence: CO 1417566670) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2020-09-16 |