| NPI | 1245037902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: OH RL339350) |
| Additional Taxonomies | 171W00000X Contractor (Licence: OH RL339350) |
| Enumeration Date | 2025-02-28 |
| Last Update Date | 2025-02-28 |