| NPI | 1053084244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH St459718) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: OH St459718) |
| Enumeration Date | 2021-07-26 |
| Last Update Date | 2021-07-26 |