| NPI | 1780181040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 347E00000X Transportation Broker |
| Additional Taxonomies | 101Y00000X Counselor |
| 146M00000X Emergency Medical Technician, Intermediate | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2018-04-12 |