| NPI | 1962876722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: MN 300595677) |
| Additional Taxonomies | 251E00000X Home Health (Licence: MN 1566943) |
| Enumeration Date | 2015-11-17 |
| Last Update Date | 2015-11-18 |