| NPI | 1922275163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver (Licence: FL 680842596) |
| Additional Taxonomies | 347C00000X Private Vehicle (Licence: FL 680842596) |
| Enumeration Date | 2008-05-15 |
| Last Update Date | 2008-05-15 |