| NPI | 1477392710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 342000000X Transportation Network Company (Licence: OH 343900000x) |
| 342000000X Transportation Network Company | |
| 342000000X Transportation Network Company | |
| 342000000X Transportation Network Company (Licence: OH 873328741) | |
| 347E00000X Transportation Broker | |
| 3747A0650X Technician, Attendant Care Provider | |
| Enumeration Date | 2024-05-24 |
| Last Update Date | 2024-05-24 |