| NPI | 1679245237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 693296) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: CA 693296) |
| Enumeration Date | 2021-10-01 |
| Last Update Date | 2021-10-01 |