NPI | 1457695736 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 240-636) |
Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: WA LPN02498) |
Enumeration Date | 2012-11-27 |
Last Update Date | 2020-08-26 |