| NPI | 1699438358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 736047) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| 146N00000X Emergency Medical Technician, Basic (Licence: E172515) | |
| Enumeration Date | 2021-10-20 |
| Last Update Date | 2023-10-17 |