| NPI | 1669513586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 33379) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2024-02-15 |