| NPI | 1952005571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA VN162089) |
| Additional Taxonomies | 333600000X Pharmacy (Licence: CA PHY45434) |
| Enumeration Date | 2023-03-28 |
| Last Update Date | 2023-09-27 |