| NPI | 1184325565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 372500000X Chore Provider | |
| Enumeration Date | 2023-03-13 |
| Last Update Date | 2023-03-13 |