| NPI | 1861975765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: MN 343900000X) |
| Additional Taxonomies | 172A00000X Driver |
| Enumeration Date | 2018-09-07 |
| Last Update Date | 2018-09-08 |