| NPI | 1720598139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 272095) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95200980) |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2019-08-08 |