| NPI | 1316794605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 724176) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2024-06-25 |