| NPI | 1639994312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 376J00000X Homemaker |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2026-05-03 |