| NPI | 1114051000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT33173) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 167G00000X Licensed Psychiatric Technician (Licence: CA 33173) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2023-07-19 |