| NPI | 1477200756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: FL 3101-1226943) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: FL R200-433-65-261-0) |
| Enumeration Date | 2022-03-07 |
| Last Update Date | 2022-03-07 |