| NPI | 1215684162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347E00000X Transportation Broker |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 174200000X Meals | |
| Enumeration Date | 2022-03-09 |
| Last Update Date | 2025-10-04 |