| NPI | 1205265246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: GA 056780190) |
| Additional Taxonomies | 171WV0202X Contractor, Vehicle Modifications (Licence: GA 0567890190) |
| 172A00000X Driver (Licence: GA 056780190) | |
| Enumeration Date | 2013-11-08 |
| Last Update Date | 2022-03-25 |