| NPI | 1184722316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT27519) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-02-22 |