| NPI | 1619103116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: OH TH763978) |
| Additional Taxonomies | 172A00000X Driver (Licence: OH TH763978) |
| 347C00000X Private Vehicle (Licence: OH TH763978) | |
| Enumeration Date | 2009-06-10 |
| Last Update Date | 2009-06-10 |