| NPI | 1912204801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: CA 11-00105968) |
| Additional Taxonomies | 343900000X Non-emergency Medical Transport (VAN) (Licence: CA 12-00010225) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2011-02-11 |