| NPI | 1639522709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT33159) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: 33159) |
| 167G00000X Licensed Psychiatric Technician | |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2024-08-07 |