| NPI | 1528761483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: TX NKK6788) |
| Additional Taxonomies | 171W00000X Contractor (Licence: TX NKK6788) |
| Enumeration Date | 2023-03-22 |
| Last Update Date | 2023-03-22 |