| NPI | 1407192297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA pt36061) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: CA vn260740) |
| Enumeration Date | 2012-12-24 |
| Last Update Date | 2023-07-05 |