| NPI | 1417811431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2025-12-13 |
| Last Update Date | 2026-02-24 |