| NPI | 1477270924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172A00000X Driver |
| Additional Taxonomies | 171WH0202X Contractor Home Modifications |
| 171WV0202X Contractor Vehicle Modifications | |
| 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2022-10-25 |