| NPI | 1194617647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: IL 043133707) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 719020) |
| Enumeration Date | 2025-07-18 |
| Last Update Date | 2025-07-18 |