| NPI | 1811760887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 732133) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2025-07-09 |