| NPI | 1861877649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN 229207) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: HI LPN 17206) |
| Enumeration Date | 2015-07-22 |
| Last Update Date | 2015-07-22 |