| NPI | 1801418728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172A00000X Driver | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2020-07-28 |