| NPI | 1619329828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QA0600X Clinic/Center Adult Day Care (Licence: CO 396UQP) |
| Additional Taxonomies | 343800000X Secured Medical Transport (VAN) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2022-08-16 |