| NPI | 1528845799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| 305S00000X Point of Service | |
| Enumeration Date | 2023-09-12 |
| Last Update Date | 2023-09-12 |