NPI | 1619456084 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 172A00000X Driver (Licence: MN H448000177616) |
Additional Taxonomies | 172A00000X Driver (Licence: MN C283025478013) |
Enumeration Date | 2018-08-07 |
Last Update Date | 2018-08-08 |