| NPI | 1053870345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 41181) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT41181) |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2023-12-01 |