| NPI | 1043008709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: MN BC808137) |
| Additional Taxonomies | 171WH0202X Contractor, Home Modifications (Licence: MN BC808137) |
| Enumeration Date | 2025-04-30 |
| Last Update Date | 2025-05-09 |