| NPI | 1568818862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 722471) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2016-05-05 |
| Last Update Date | 2022-03-15 |