| NPI | 1790426229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: NY 611417496) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: NY 611471496) |
| Enumeration Date | 2022-04-06 |
| Last Update Date | 2022-04-06 |