| NPI | 1316641251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor |
| Additional Taxonomies | 171WH0202X Contractor, Home Modifications |
| 171WV0202X Contractor, Vehicle Modifications | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2023-03-27 |