| NPI | 1508217621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 710360) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 215583) |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2022-06-27 |