| NPI | 1811148497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA vn175235) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: HI lpn15758) |
| 164X00000X Licensed Vocational Nurse (Licence: AZ lp021107) | |
| 374U00000X Home Health Aide | |
| Enumeration Date | 2008-10-01 |
| Last Update Date | 2010-02-01 |