| NPI | 1427694504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: NY 911482417) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: NY 911482417) |
| 344600000X Taxi (Licence: NY 911482417) | |
| Enumeration Date | 2019-11-23 |
| Last Update Date | 2019-11-23 |