| NPI | 1700259702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 291U00000X Clinical Medical Laboratory |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: TX 11788454) | |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2018-08-01 |