| NPI | 1255704094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95298217) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT 38216) |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2022-09-20 |