NPI | 1396122628 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 172A00000X Driver (Licence: MS 802244595) |
Additional Taxonomies | 172A00000X Driver (Licence: MS 802061140) |
Enumeration Date | 2015-05-06 |
Last Update Date | 2015-05-06 |