| NPI | 1275644718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 26900) |
| 225800000X Recreation Therapist | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2024-06-17 |