| NPI | 1972029189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 343900000X Non-emergency Medical Transport (VAN) (Licence: CA D7169245) |
| Additional Taxonomies | 172A00000X Driver |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2023-03-17 |