| NPI | 1003391996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: KS K03-37-9324) |
| Additional Taxonomies | 172A00000X Driver (Licence: KS K01-11-1884) |
| Enumeration Date | 2018-09-26 |
| Last Update Date | 2018-09-26 |