| NPI | 1104458280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 703054) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041453102) |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2020-02-06 |