| NPI | 1003391384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA Pt31062) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 31062) |
| Enumeration Date | 2018-10-02 |
| Last Update Date | 2018-10-02 |