| NPI | 1033781760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 715724) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 715721) |
| Enumeration Date | 2021-07-13 |
| Last Update Date | 2023-05-08 |