Individual
BAW SU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
341 OLIVER ST, N TONAWANDA, NY 14120-7227
(716) 628-6370
Mailing address
341 OLIVER ST, N TONAWANDA, NY 14120-7227
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Enumeration date
05/27/2020
Last updated
05/27/2020
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