| NPI | 1538936513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: LA 006458072) |
| Additional Taxonomies | 172A00000X Driver |
| Enumeration Date | 2023-12-08 |
| Last Update Date | 2024-03-21 |