| NPI | 1477639946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT30173) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2011-05-25 |