| NPI | 1730584129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 169560) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN169560) |
| Enumeration Date | 2014-10-28 |
| Last Update Date | 2014-10-28 |