| NPI | 1275254831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: NY 421399170) |
| Additional Taxonomies | 172A00000X Driver (Licence: NY 812049081) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2024-02-22 |