| NPI | 1619869864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171W00000X Contractor (Licence: OH 201918601258) |
| Additional Taxonomies | 171WH0202X Contractor, Home Modifications |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-07-21 |