| NPI | 1811296551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: PA PA077942) |
| Additional Taxonomies | 171WH0202X Contractor Home Modifications (Licence: PA PA077942) |
| 171WV0202X Contractor Vehicle Modifications (Licence: PA PA077942) | |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2011-03-21 |