| NPI | 1013772854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: FL H250259773630) |
| Additional Taxonomies | 172A00000X Driver (Licence: FL B200541684090) |
| Enumeration Date | 2024-02-20 |
| Last Update Date | 2024-02-20 |