| NPI | 1386004299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 27177) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT27177) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2025-12-15 |