| NPI | 1457717886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 38197) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2022-10-04 |