| NPI | 1679845457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: AZ 10194707) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: AZ 10194707) |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2012-02-08 |
| Last Update Date | 2013-06-10 |