| NPI | 1639944465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 739291) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: GA LPN097723) |
| Enumeration Date | 2023-11-21 |
| Last Update Date | 2024-03-06 |