| NPI | 1003163270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA LPT42462) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2023-02-28 |