| NPI | 1043744790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: TX 24512126) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: TX 24512126) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2017-04-19 |