| NPI | 1912353343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) |
| Additional Taxonomies | 172A00000X Driver (Licence: ND GIL-70-9863) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2026-06-12 |