| 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 |