| NPI | 1134391923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN211921) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 211921) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2023-03-15 |