| NPI | 1568773513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 35398) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2024-02-23 |