| NPI | 1801689922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172A00000X Driver (Licence: MN v942200598315) |
| Additional Taxonomies | 172A00000X Driver (Licence: v942200598315) |
| Enumeration Date | 2025-05-22 |
| Last Update Date | 2025-05-22 |