| NPI | 1982316287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 729076) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA 729076) |
| Enumeration Date | 2022-12-19 |
| Last Update Date | 2026-01-26 |