| NPI | 1649800418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 704207) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 714207) |
| Enumeration Date | 2020-01-21 |
| Last Update Date | 2020-10-27 |