| NPI | 1922154806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN 225437) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: TX 203982) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-07-08 |