| NPI | 1740692540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN 276219) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN276219) |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2020-09-17 |