| NPI | 1336257757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: FL A514-520-43-100-0) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 690160396) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2007-07-08 |