| NPI | 1396479606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 42379) |
| Additional Taxonomies | 376K00000X Nurse's Aide |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2024-01-12 |