NPI | 1255045720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 32526) |
Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
Enumeration Date | 2023-01-10 |
Last Update Date | 2024-04-12 |