| NPI | 1699926311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: GA 055069601) |
| Additional Taxonomies | 171WV0202X Contractor, Vehicle Modifications |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2012-04-20 |