| NPI | 1285161646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 718274) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NY 333052) |
| 164W00000X Licensed Practical Nurse (Licence: OH 160077) | |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2025-11-25 |