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 |