| NPI | 1346889318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 42287) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-12-23 |
| Last Update Date | 2022-08-04 |