| NPI | 1841154804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171WV0202X Contractor, Vehicle Modifications |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) |
| Enumeration Date | 2025-12-15 |
| Last Update Date | 2025-12-15 |