| NPI | 1922813476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 734104) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-02-11 |
| Last Update Date | 2025-02-11 |