| NPI | 1679412456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: CA vn202319) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA vn202319) |
| Enumeration Date | 2026-03-26 |
| Last Update Date | 2026-03-26 |