| NPI | 1083248728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171WH0202X Contractor, Home Modifications (Licence: TX 20414) |
| Additional Taxonomies | 171W00000X Contractor (Licence: TX 20414) |
| 171WV0202X Contractor, Vehicle Modifications | |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2021-03-25 |