| NPI | 1649538901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN242941) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 242941) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2023-06-22 |