| NPI | 1619612017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 745979) |
| Additional Taxonomies | 376K00000X Nurse's Aide (Licence: CA 01202646) |
| Enumeration Date | 2022-04-29 |
| Last Update Date | 2025-02-06 |