| NPI | 1275030843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN216427) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 216427) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2018-04-10 |