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 |