| NPI | 1336642503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 690904) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: CA 690904) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2018-03-14 |