| NPI | 1407736010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: OH HRC-18-00004) |
| Additional Taxonomies | 171WH0202X Contractor Home Modifications (Licence: OH HRC-18-00004) |
| Enumeration Date | 2025-09-04 |
| Last Update Date | 2025-09-04 |