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 |