| NPI | 1013295427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 42104) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2011-08-02 |
| Last Update Date | 2025-01-18 |