| NPI | 1417818063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: NJ 15945447906672) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: NJ 15945447906672) |
| 347C00000X Private Vehicle (Licence: NJ 15945447906672) | |
| Enumeration Date | 2025-11-22 |
| Last Update Date | 2025-11-22 |