| NPI | 1205174711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT15664) |
| Additional Taxonomies | 374700000X Technician (Licence: CA PT15664) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2024-08-16 |