| NPI | 1831828607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 719074) |
| Additional Taxonomies | 2471V0105X Radiologic Technologist, Vascular Sonography (Licence: CA 111276) |
| Enumeration Date | 2022-06-07 |
| Last Update Date | 2022-06-07 |