| NPI | 1720650260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 3747A0650X Technician, Attendant Care Provider |
| Additional Taxonomies | 171WH0202X Contractor, Home Modifications |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-07-14 |