| NPI | 1861679474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: IA 842ZZ1775) |
| Additional Taxonomies | 171WH0202X Contractor Home Modifications (Licence: IA 842ZZ1775) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2008-01-25 |