| NPI | 1306192679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT40247) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WI 4087) |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2017-11-14 |