| NPI | 1336918952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 35208) |
| Additional Taxonomies | 101200000X Drama Therapist (Licence: CA 35208) |
| Enumeration Date | 2023-12-22 |
| Last Update Date | 2025-08-01 |