NPI | 1003221722 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN281175) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA VN 281175) |
Enumeration Date | 2014-06-23 |
Last Update Date | 2019-02-07 |