| NPI | 1255196309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 744950) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E159539) |
| Enumeration Date | 2024-02-19 |
| Last Update Date | 2024-08-26 |