| NPI | 1477259356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: AZ 3031899) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 251S00000X Community/Behavioral Health (Licence: AZ SLH10481) | |
| Enumeration Date | 2023-02-02 |
| Last Update Date | 2023-02-02 |