| NPI | 1689412769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347C00000X Private Vehicle |
| Additional Taxonomies | 172A00000X Driver |
| 343900000X Non-emergency Medical Transport (VAN) | |
| Enumeration Date | 2024-07-15 |
| Last Update Date | 2024-10-16 |