| NPI | 1972965093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 270511) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA 270511) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2021-12-09 |