| NPI | 1487288080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: OH SD750143) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: OH SD750143) |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2020-02-24 |